Clinical Strategy of Repeat Biopsy in Patients with Atypical Small Acinar Proliferation (ASAP)

Overview

Journal Sci Rep

Specialty Science

Date 2021 Dec 1

PMID 34848744

Citations 2

Authors

Hwanik Kim

Jung Kwon Kim

Gheeyoung Choe

Sung Kyu Hong

Affiliations

Soon will be listed here.

Abstract

Atypical small acinar proliferation (ASAP) occurs in approximately 5% of prostate biopsies. Approximately 30-40% of patients with ASAP have biopsy detectable prostate cancer (PCa) within 5 years. Current guidelines recommend a repeat biopsy within 3-6 months after the initial diagnosis. The aim of the present study was to examine the association between ASAP and subsequent diagnosis of clinically significant PCa (csPCa). The need for immediate repeat biopsy was also evaluated. We identified 212 patients with an ASAP diagnosis on their first biopsy at our institution between February 2006 and March 2018. Of these patients, 102 (48.1%) had at least one follow-up biopsy. Clinicopathologic features including rates of subsequent PCa and csPCa were assessed. Thirty-five patients subsequently underwent radical prostatectomy (RP). Their pathologic results were reviewed. csPCa was defined as the presence of Gleason score (GS) ≥ 3 + 4 in ≥ 1 biopsy core. Adverse pathology (AP) was defined as high-grade (primary Gleason pattern ≥ 4) or non-organ-confined disease (pT3/N1) after RP. Of 102 patients, 87 (85.3%), 13 (12.7%), and 2 (2.0%) had one, two, and three follow-up biopsies, respectively. Median time from the initial ASAP diagnosis to the 2nd follow-up biopsy and the last follow-up biopsy were 21.9 months (range 1-129 months) and 27.7 months (range 1-129 months), respectively. Of these patients, 46 (45.1%) were subsequently diagnosed with PCa, including 20 (19.6%) with csPCa. Only 2 (2.0%) patients had GS ≥ 8 disease. Five (4.9%) patients had number of positive cores > 3. Of 35 patients who subsequently underwent RP, seven (20%) had AP after RP and 17 (48.6%) showed GS upgrading. Of these 17 patients, the vast majority (16/17, 94.1%) had GS upgrading from 3 + 3 to 3 + 4. 45.1% of patients with an initial diagnosis of ASAP who had repeat prostate biopsy were subsequently diagnosed with PCa and 19.6% were found to have csPCa. Our findings add further evidence that after a diagnosis of ASAP, a repeat biopsy is warranted and that the repeat biopsy should not be postponed.

Citing Articles

Follow-up on patients with initial negative mpMRI target and systematic biopsy for PI-RADS ≥ 3 lesions-an EAU-YAU study enhancing prostate cancer detection.

Amir K, Siddiqui M Prostate Cancer Prostatic Dis. 2024; .

PMID: 39433888 DOI: 10.1038/s41391-024-00912-1.

Prostate cancer detection after atypical small acinar proliferation (ASAP): A 10-year single-centre cohort.

Anbarasan T, Raslan M, Ghosh K, Macklin P, Mercader C, Leslie T BJUI Compass. 2024; 5(9):834-836.

PMID: 39323925 PMC: 11420094. DOI: 10.1002/bco2.407.

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